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Engel-Rebitzer E, Dolan A, Shofer FS, Schapira MM, Hess EP, Rhodes KV, Bellamkonda VR, Msw EG, Bell J, Schwarz L, Schiller E, Lewis-Salley D, McCollum S, Zyla M, Becker LB, Graves RL, Meisel ZF. The association between specific narrative elements and patient perspectives on acute pain treatment. Am J Emerg Med 2023; 74:84-89. [PMID: 37797399 PMCID: PMC10924766 DOI: 10.1016/j.ajem.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Narratives are effective tools for communicating with patients about opioid prescribing for acute pain and improving patient satisfaction with pain management. It remains unclear, however, whether specific narrative elements may be particularly effective at influencing patient perspectives. METHODS This study was a secondary analysis of data collected for Life STORRIED, a multicenter RCT. Participants included 433 patients between 18 and 70 years-old presenting to the emergency department (ED) with renal colic or musculoskeletal back pain. Participants were instructed to view one or more narrative videos during their ED visit in which a patient storyteller discussed their experiences with opioids. We examined associations between exposure to individual narrative features and patients' 1) preference for opioids, 2) recall of opioid-related risks and 3) perspectives about the care they received. RESULTS Participants were more likely to watch videos featuring storytellers who shared their race or gender. We found that participants who watched videos that contained specific narrative elements, for example mention of prescribed opioids, were more likely to recall having received information about pain treatment options on the day after discharge (86.3% versus 72.9%, p = 0.02). Participants who watched a video that discussed family history of addiction reported more participation in their treatment decision than those who did not (7.6 versus 6.8 on a ten-point scale, p = 0.04). CONCLUSIONS Participants preferentially view narratives featuring storytellers who share their race or gender. Narrative elements were not meaningfully associated with patient-centered outcomes. These findings have implications for the design of narrative communication tools.
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Affiliation(s)
- Eden Engel-Rebitzer
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA; Brigham and Women's Hospital, Boston, MA, USA.
| | - Abby Dolan
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA; Urban Health Lab at the Penn Medicine Center for Health Justice, Perelman School of Medicine at the University of Pennsylvania, USA; Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Frances S Shofer
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA; Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Marilyn M Schapira
- Center for Health Equity Research and Promotion (CHERP), Philadelphia VA Medical Center, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; University of Pennsylvania Department of General and Internal Medicine, Philadelphia, PA, USA
| | - Erik P Hess
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN, USA
| | - Karin V Rhodes
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Venkatesh R Bellamkonda
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Erica Goldberg Msw
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey Bell
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Linda Schwarz
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Elise Schiller
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Dena Lewis-Salley
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon McCollum
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Zyla
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Lance B Becker
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Rachel Lynn Graves
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Zachary F Meisel
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA; Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA 19104, USA
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2
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Nguemeni Tiako MJ, Shofer F, Dolan A, Goldberg EB, Rhodes KV, Hess EP, Bellamkonda VR, Perrone J, Cannuscio CC, Becker L, Rodgers MA, Zyla MM, Bell JJ, McCollum S, Engel-Rebitzer E, Schapira MM, Meisel ZF. Personalized risk communication and opioid prescribing in association with nonprescribed opioid use: A secondary analysis of a randomized controlled trial. Acad Emerg Med 2023; 30:851-858. [PMID: 36869633 DOI: 10.1111/acem.14710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/15/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND To determine the impact of personalized risk communication and opioid prescribing on nonprescribed opioid use, we conducted a secondary analysis of randomized controlled trial participants followed prospectively for 90 days after an emergency department (ED) visit for acute back or kidney stone pain. METHODS A total of 1301 individuals were randomized during an encounter at four academic EDs into a probabilistic risk tool (PRT) arm, a narrative-enhanced PRT arm, or a general risk information arm (control). In this secondary analysis, both risk tool arms were combined and compared with the control arm. We used logistic regressions to determine associations between receiving personalized risk information, receiving an opioid prescription in the ED, and nonprescribed opioid use in general and by race. RESULTS Complete follow-up data were available for 851 participants; 23.3% (n = 198) were prescribed opioids (34.2% of White vs. 11.6% of Black participants, p < 0.001). Fifty-six (6.6%) participants used nonprescribed opioids. Participants in the personalized risk communication arms had lower nonprescribed opioid use odds (adjusted odds ratio [aOR] 0.58, 95% confidence interval [CI] 0.4-0.83). Black versus White participants had greater nonprescribed opioid use odds (aOR 3.47, 95% CI 2.05-5.87, p < 0.001). Black participants who were prescribed opioids had a lower marginal probability of using nonprescribed opioids versus those who were not (0.06, 95% CI 0.04-0.08, p < 0.001 vs. 0.10, 95% CI 0.08-0.11, p < 0.001). The absolute risk difference in nonprescribed opioid use for Black and White participants, respectively, in the risk communication versus the control arm, was 9.7% and 0.1% (relative risk ratio 0.43 vs. 0.95). CONCLUSIONS Among Black but not White participants, personalized opioid risk communication and opioid prescribing were associated with lower odds of nonprescribed opioid use. Our findings suggest that racial disparities in opioid prescribing-which have been previously described within the context of this trial-may paradoxically increase nonprescribed opioid use. Personalized risk communication may effectively reduce nonprescribed opioid use, and future research should be designed specifically to explore this possibility in a larger cohort.
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Affiliation(s)
- Max Jordan Nguemeni Tiako
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frances Shofer
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abby Dolan
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica B Goldberg
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karin V Rhodes
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Erik P Hess
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Venkatesh R Bellamkonda
- Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeanmarie Perrone
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carolyn C Cannuscio
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lance Becker
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Melissa A Rodgers
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael M Zyla
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey J Bell
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sharon McCollum
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eden Engel-Rebitzer
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marilyn M Schapira
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Hospital, Philadelphia, Pennsylvania, USA
| | - Zachary F Meisel
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Nv B, McCollum S, Faherty E, Steele JM, Karnik R. Longitudinal Assessment of Left Ventricular Function in Patients with Myopericarditis After mRNA COVID-19 Vaccination. Pediatr Cardiol 2023:10.1007/s00246-023-03200-2. [PMID: 37294336 PMCID: PMC10251331 DOI: 10.1007/s00246-023-03200-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/27/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Multiple reports have described myopericarditis following mRNA COVID-19 vaccination. However, data on the persistence of subclinical myocardial injury assessed by left ventricular (LV) longitudinal strain (LVLS) is limited. OBJECTIVES Our aim was to assess LV function longitudinally in our cohort of COVID-19 vaccine-related myopericarditis using ejection fraction (EF), fractional shortening (FS), LVLS, and diastolic parameters. METHODS Retrospective, single-center review of demographic, laboratory, and management data was performed on 20 patients meeting diagnostic criteria for myopericarditis after mRNA COVID-19 vaccination. Echocardiographic images were obtained on initial presentation (time 0), at a median of 12 days (7.5, 18.5; time 1), and at a median of 44 days (29.5, 83.5; time 2). FS was calculated by M-mode, EF by 5/6 area-length methods, LVLS by utilization of TOMTEC software, and diastolic function by tissue Doppler. All parameters were compared across pairs of these time points using Wilcoxon signed-rank test. RESULTS Our cohort consisted predominantly of adolescent males (85%) with mild presentation of myopericarditis. The median EF was 61.6% (54.6, 68.0), 63.8% (60.7, 68.3), 61.4% (60.1, 64.6) at times 0, 1, and 2, respectively. Upon initial presentation, 47% of our cohort had LVLS < -18%. The median LVLS was -18.6% (-16.9, -21.0) at time 0, -21.2% at time 1 (-19.4, -23.5) (p = 0.004) and -20.8% (-18.7, -21.7) at time 2 (p = 0.004, as compared to time 0). CONCLUSIONS Though many of our patients had abnormal strain during acute illness, LVLS improved longitudinally, indicating myocardial recovery. LVLS can be used as marker of subclinical myocardial injury and risk stratification in this population.
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Affiliation(s)
- Barresi Nv
- Yale University School of Medicine, 20 York Street, New Haven, CT, 06510, USA.
| | - S McCollum
- Yale University School of Medicine, 20 York Street, New Haven, CT, 06510, USA
| | - E Faherty
- Section of Pediatric Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - J M Steele
- Section of Pediatric Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - R Karnik
- Section of Pediatric Cardiology, Yale University School of Medicine, New Haven, CT, USA
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4
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Meisel ZF, Shofer F, Dolan A, Goldberg EB, Rhodes KV, Hess EP, Bellamkonda VR, Perrone J, Cannuscio CC, Becker L, Rodgers MA, Zyla MM, Bell JJ, McCollum S, Engel-Rebitzer E, Tiako MJN, Ridgeway G, Schapira MM. A Multicentered Randomized Controlled Trial Comparing the Effectiveness of Pain Treatment Communication Tools in Emergency Department Patients With Back or Kidney Stone Pain. Am J Public Health 2022; 112:S45-S55. [PMID: 35143273 PMCID: PMC8842217 DOI: 10.2105/ajph.2021.306511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To compare the effectiveness of 3 approaches for communicating opioid risk during an emergency department visit for a common painful condition. Methods. This parallel, multicenter randomized controlled trial was conducted at 6 geographically disparate emergency department sites in the United States. Participants included adult patients between 18 and 70 years of age presenting with kidney stone or musculoskeletal back pain. Participants were randomly assigned to 1 of 3 risk communication strategies: (1) a personalized probabilistic risk visual aid, (2) a visual aid and a video narrative, or 3) general risk information. The primary outcomes were accuracy of risk recall, reported opioid use, and treatment preference at time of discharge. Results. A total of 1301 participants were enrolled between June 2017 and August 2019. There was no difference in risk recall at 14 days between the narrative and probabilistic groups (43.7% vs 38.8%; absolute risk reduction = 4.9%; 95% confidence interval [CI] = -2.98, 12.75). The narrative group had lower rates of preference for opioids at discharge than the general risk information group (25.9% vs 33.0%; difference = 7.1%; 95% CI = 0.64, 0.97). There were no differences in reported opioid use at 14 days between the narrative, probabilistic, and general risk groups (10.5%, 10.3%, and 13.3%, respectively; P = .44). Conclusions. An emergency medicine communication tool incorporating probabilistic risk and patient narratives was more effective than general information in mitigating preferences for opioids in the treatment of pain but was not more effective with respect to opioid use or risk recall. Trial Registration. Clinical Trials.gov identifier: NCT03134092. (Am J Public Health. 2022;112(S1):S45-S55. https://doi.org/10.2105/AJPH.2021.306511).
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Affiliation(s)
- Zachary F Meisel
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
| | - Frances Shofer
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
| | - Abby Dolan
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
| | - Erica B Goldberg
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
| | - Karin V Rhodes
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
| | - Erik P Hess
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
| | - Venkatesh R Bellamkonda
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
| | - Jeanmarie Perrone
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
| | - Carolyn C Cannuscio
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
| | - Lance Becker
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
| | - Melissa A Rodgers
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
| | - Michael M Zyla
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
| | - Jeffrey J Bell
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
| | - Sharon McCollum
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
| | - Eden Engel-Rebitzer
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
| | - Max Jordan Nguemeni Tiako
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
| | - Greg Ridgeway
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
| | - Marilyn M Schapira
- Zachary F. Meisel, Frances Shofer, Abby Dolan, Erica B. Goldberg, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum, Eden Engel-Rebitzer, and Max Jordan Nguemeni Tiako are with the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Karin V. Rhodes is with the Agency for Healthcare Research and Quality, Bethesda, MD. Erik P. Hess is with the Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN. Venkatesh R. Bellamkonda is with the Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN. Jeanmarie Perrone is with the Center for Addiction Medicine and Policy, University of Pennsylvania. Lance Becker is with the Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY. Carolyn C. Cannuscio is with the Center for Public Health Initiatives, University of Pennsylvania. Greg Ridgeway is with the Department of Criminology, University of Pennsylvania. Marilyn M. Schapira is with the Center for Health Equity and Research Promotion, Philadelphia VA Medical Center
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Engel-Rebitzer E, Dolan AR, Aronowitz SV, Shofer FS, Nguemeni Tiako MJ, Schapira MM, Perrone J, Hess EP, Rhodes KV, Bellamkonda VR, Cannuscio CC, Goldberg E, Bell J, Rodgers MA, Zyla M, Becker LB, McCollum S, Meisel ZF. Patient Preference and Risk Assessment in Opioid Prescribing Disparities: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2118801. [PMID: 34323984 PMCID: PMC8322998 DOI: 10.1001/jamanetworkopen.2021.18801] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Although racial disparities in acute pain control are well established, the role of patient analgesic preference and the factors associated with these disparities remain unclear. OBJECTIVE To characterize racial disparities in opioid prescribing for acute pain after accounting for patient preference and to test the hypothesis that racial disparities may be mitigated by giving clinicians additional information about their patients' treatment preferences and risk of opioid misuse. DESIGN, SETTING, AND PARTICIPANTS This study is a secondary analysis of data collected from Life STORRIED (Life Stories for Opioid Risk Reduction in the ED), a multicenter randomized clinical trial conducted between June 2017 and August 2019 in the emergency departments (EDs) of 4 academic medical centers. Participants included 1302 patients aged 18 to 70 years who presented to the ED with ureter colic or musculoskeletal back and/or neck pain. INTERVENTIONS The treatment arm was randomized to receive a patient-facing intervention (not examined in this secondary analysis) and a clinician-facing intervention that consisted of a form containing information about each patient's analgesic treatment preference and risk of opioid misuse. MAIN OUTCOMES AND MEASURES Concordance between patient preference for opioid-containing treatment (assessed before ED discharge) and receipt of an opioid prescription at ED discharge. RESULTS Among 1302 participants in the Life STORRIED clinical trial, 1012 patients had complete demographic and treatment preference data available and were included in this secondary analysis. Of those, 563 patients (55.6%) self-identified as female, with a mean (SD) age of 40.8 (14.1) years. A total of 455 patients (45.0%) identified as White, 384 patients (37.9%) identified as Black, and 173 patients (17.1%) identified as other races. After controlling for demographic characteristics and clinical features, Black patients had lower odds than White patients of receiving a prescription for opioid medication at ED discharge (odds ratio [OR], 0.42; 95% CI, 0.27-0.65). When patients who did and did not prefer opioids were considered separately, Black patients continued to have lower odds of being discharged with a prescription for opioids compared with White patients (among those who preferred opioids: OR, 0.43 [95% CI, 0.24-0.77]; among those who did not prefer opioids: OR, 0.45 [95% CI, 0.23-0.89]). These disparities were not eliminated in the treatment arm, in which clinicians were given additional data about their patients' treatment preferences and risk of opioid misuse. CONCLUSIONS AND RELEVANCE In this secondary analysis of data from a randomized clinical trial, Black patients received different acute pain management than White patients after patient preference was accounted for. These disparities remained after clinicians were given additional patient-level data, suggesting that a lack of patient information may not be associated with opioid prescribing disparities. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03134092.
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Affiliation(s)
- Eden Engel-Rebitzer
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
| | - Abby R. Dolan
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Frances S. Shofer
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Max Jordan Nguemeni Tiako
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Yale School of Medicine, New Haven, Connecticut
| | - Marilyn M. Schapira
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of General and Internal Medicine, University of Pennsylvania, Philadelphia
| | - Jeanmarie Perrone
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Penn Center for Addiction Medicine and Policy, Philadelphia, Pennsylvania
| | - Erik P. Hess
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Karin V. Rhodes
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Venkatesh R. Bellamkonda
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Carolyn C. Cannuscio
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
| | - Erica Goldberg
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
| | - Jeffrey Bell
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
| | - Melissa A. Rodgers
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- College of Education, University of Texas at Austin, Austin
| | - Michael Zyla
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
| | - Lance B. Becker
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Sharon McCollum
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
| | - Zachary F. Meisel
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
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Meisel ZF, Goldberg EB, Dolan AR, Bansal E, Rhodes KV, Hess EP, Cannuscio CC, Schapira MM, Perrone J, Rodgers MA, Zyla MM, Bell JJ, McCollum S, Shofer FS. Stories to Communicate Individual Risk for Opioid Prescriptions for Back and Kidney Stone Pain: Protocol for the Life STORRIED Multicenter Randomized Clinical Trial. JMIR Res Protoc 2020; 9:e19496. [PMID: 32969832 PMCID: PMC7545334 DOI: 10.2196/19496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/07/2020] [Accepted: 07/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background Prescription opioid misuse in the United States is a devastating public health crisis; many chronic opioid users were originally prescribed this class of medication for acute pain. Video narrative–enhanced risk communication may improve patient outcomes, such as knowledge of opioid risk and opioid use behaviors after an episode of acute pain. Objective Our objective is to assess the effect of probabilistic and narrative-enhanced opioid risk communication on patient-reported outcomes, including knowledge, opioid use, and patient preferences, for patients who present to emergency departments with back pain and kidney stone pain. Methods This is a multisite randomized controlled trial. Patients presenting to the acute care facilities of four geographically and ethnically diverse US hospital centers with acute renal colic pain or musculoskeletal back and/or neck pain are eligible for this randomized controlled trial. A control group of patients receiving general risk information is compared to two intervention groups: one receiving the risk information sheet plus an individualized, visual probabilistic Opioid Risk Tool (ORT) and another receiving the risk information sheet plus a video narrative–enhanced probabilistic ORT. We will study the effect of probabilistic and narrative-enhanced opioid risk communication on the following: risk awareness and recall at 14 days postenrollment, reduced use or preferences for opioids after the emergency department episode, and alignment with patient preference and provider prescription. To assess these outcomes, we administer baseline patient surveys during acute care admission and follow-up surveys at predetermined times during the 3 months after discharge. Results A total of 1302 patients were enrolled over 24 months. The mean age of the participants was 40 years (SD 14), 692 out of 1302 (53.15%) were female, 556 out of 1302 (42.70%) were White, 498 out of 1302 (38.25%) were Black, 1002 out of 1302 (76.96%) had back pain, and 334 out of 1302 (25.65%) were at medium or high risk. Demographics and ORT scores were equally distributed across arms. Conclusions This study seeks to assess the potential clinical role of narrative-enhanced, risk-informed communication for acute pain management in acute care settings. This paper outlines the protocol used to implement the study and highlights crucial methodological, statistical, and stakeholder involvement as well as dissemination considerations. Trial Registration ClinicalTrials.gov NCT03134092; https://clinicaltrials.gov/ct2/show/NCT03134092 International Registered Report Identifier (IRRID) DERR1-10.2196/19496
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Affiliation(s)
- Zachary F Meisel
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Erica B Goldberg
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Abby R Dolan
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Esha Bansal
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Karin V Rhodes
- Department of Population Health Management, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
| | - Erik P Hess
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Carolyn C Cannuscio
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Marilyn M Schapira
- Department of General and Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeanmarie Perrone
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Melissa A Rodgers
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael M Zyla
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeffrey J Bell
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Sharon McCollum
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Frances S Shofer
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Kangovi S, Mitra N, Grande D, White ML, McCollum S, Sellman J, Shannon RP, Long JA. Patient-centered community health worker intervention to improve posthospital outcomes: a randomized clinical trial. JAMA Intern Med 2014; 174:535-43. [PMID: 24515422 DOI: 10.1001/jamainternmed.2013.14327] [Citation(s) in RCA: 180] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Socioeconomic and behavioral factors can negatively influence posthospital outcomes among patients of low socioeconomic status (SES). Traditional hospital personnel often lack the time, skills, and community linkages required to address these factors. OBJECTIVE To determine whether a tailored community health worker (CHW) intervention would improve posthospital outcomes among low-SES patients. DESIGN, SETTING, AND PARTICIPANTS A 2-armed, single-blind, randomized clinical trial was conducted between April 10, 2011, and October 30, 2012, at 2 urban, academically affiliated hospitals. Of 683 eligible general medical inpatients (ie, low-income, uninsured, or Medicaid) that we screened, 237 individuals (34.7%) declined to participate. The remaining 446 patients (65.3%) were enrolled and randomly assigned to study arms. Nearly equal percentages of control and intervention group patients completed the follow-up interview (86.6% vs 86.9%). INTERVENTIONS During hospital admission, CHWs worked with patients to create individualized action plans for achieving patients' stated goals for recovery. The CHWs provided support tailored to patient goals for a minimum of 2 weeks. MAIN OUTCOMES AND MEASURES The prespecified primary outcome was completion of primary care follow-up within 14 days of discharge. Prespecified secondary outcomes were quality of discharge communication, self-rated health, satisfaction, patient activation, medication adherence, and 30-day readmission rates. RESULTS Using intention-to-treat analysis, we found that intervention patients were more likely to obtain timely posthospital primary care (60.0% vs 47.9%; P = .02; adjusted odds ratio [OR], 1.52; 95% CI, 1.03-2.23), to report high-quality discharge communication (91.3% vs 78.7%; P = .002; adjusted OR, 2.94; 95% CI, 1.5-5.8), and to show greater improvements in mental health (6.7 vs 4.5; P = .02) and patient activation (3.4 vs 1.6; P = .05). There were no significant differences between groups in physical health, satisfaction with medical care, or medication adherence. Similar proportions of patients in both arms experienced at least one 30-day readmission; however, intervention patients were less likely to have multiple 30-day readmissions (2.3% vs 5.5%; P = .08; adjusted OR, 0.40; 95% CI, 0.14-1.06). Among the subgroup of 63 readmitted patients, recurrent readmission was reduced from 40.0% vs 15.2% (P = .03; adjusted OR, 0.27; 95% CI, 0.08-0.89). CONCLUSIONS AND RELEVANCE Patient-centered CHW intervention improves access to primary care and quality of discharge while controlling recurrent readmissions in a high-risk population. Health systems may leverage the CHW workforce to improve posthospital outcomes by addressing behavioral and socioeconomic drivers of disease. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01346462.
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Affiliation(s)
- Shreya Kangovi
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia2Penn Center for Community Health Workers, University of Pennsylvania, Philadelphia3Spectrum Health Services, Inc, Philadelphia, Pennsylvania4Leonard Davis Institu
| | - Nandita Mitra
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia5Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia
| | - David Grande
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia4Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia6Robert Wood Johnson Foundation Clinical Scholars Program, University of Penn
| | - Mary L White
- Penn Center for Community Health Workers, University of Pennsylvania, Philadelphia
| | - Sharon McCollum
- Penn Center for Community Health Workers, University of Pennsylvania, Philadelphia
| | - Jeffrey Sellman
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Richard P Shannon
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Judith A Long
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia4Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia6Robert Wood Johnson Foundation Clinical Scholars Program, University of Penn
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Currie J, McCollum S, Hughes C. 1021 POSTER Action Cancer: digital mammography with satellite transmission on a mobile unit. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70616-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Affiliation(s)
- A Reisenauer
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California 94305-5329, USA.
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McCollum S. The Lentaigne manuscript: an account by John of Arderne of his treatment of fistula-in-ano. J Ir Coll Physicians Surg 1996; 25:214-6. [PMID: 11616299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
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Atkins H, Brock, McAuliffe-Curtin J, Drake C, Duff F, Dunlop G, Dunphy JE, Du Plessis DJ, Hughes E, Kay AW, Longmire W, Louw J, McCollum S, Platt H, Porritt, Salter R, Sellors TH, Smith, Stinchfield F, Welch C, Wright R. Co-operation over surgical training. West J Med 1979. [DOI: 10.1136/bmj.1.6179.1708-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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